MEDICARE: MS. ANDREA CORNACHIO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	078832-1	NY
2	1041C0700X	Clinical Social Worker	082895	NY

General Provider Information

NPI Number	:	1649425992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA CORNACHIO LCSW

Provider Business Mailing Address
First Line	:	31 POPLAR AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-1443
Country	:	US
Telephone Number	:	516-924-0484
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 FULTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-2451
Country	:	US
Telephone Number	:	718-579-0805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2008
Last Update Date	:	05/19/2015

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